Removing collaborative practice agreements boosts healthcare access
Nurse practitioners and certified nurse midwives are known as “advanced practice registered nurses” (APRNs). They’re an essential category of medical professionals who work on the frontlines of patient care, especially in rural and underserved areas. But in many states, APRNs’ ability to provide care is limited by collaborative practice agreements.
Collaborative practice agreements are legally binding contracts between APRNs (or other similar health professionals) and licensed physicians. When they’re required by states, they prevent APRNs from practicing independently. Collaborative practice agreements vary state by state but generally stipulate practice settings, permitted medical functions, supervision requirements, or prescriptive authority.
A new report
New research from Pacific Legal Foundation highlights how CPAs can restrict entrepreneurship among APRNs, increase healthcare costs, and reduce patient access to care. While 35 states now allow APRNs the opportunity to practice independently or transition to independent practice over time, 16 states still require full CPAs or similar arrangements.
Our report compares CPA laws and regulations across the 50 states and shows how supervision requirements—like those in California and Nebraska—limit opportunities for independent practice. In addition to restricting the rights of APRNs to earn a living, the financial burden associated with establishing and maintaining a CPA can be cost prohibitive: Some APRNs report paying thousands annually just to maintain a supervisory relationship. Meanwhile, scholarly research finds no evidence that CPAs improve patient safety or outcomes.
States that allow independent practice for APRNs enjoy improved healthcare access, lower costs, and higher patient satisfaction. Women in states where CNMs can practice independently, moreover, are more likely to access midwifery services and home birth options without negative effects on birth outcomes. Mental health patients, especially those in rural areas, also benefit from increased provider availability.
Fighting in court
APRNs have the right to serve their communities while earning a living in the manner of their choosing, free from unreasonable government restrictions.
PLF is representing two nurse practitioners in a lawsuit challenging California’s complex restrictions. We also represent a nurse midwife in a lawsuit challenging Nebraska’s burdensome supervision mandate.
States should remove these unnecessary restrictions and allow highly skilled, entrepreneurial APRNs to help ensure patients receive the timely, affordable, and high-quality care they deserve. When they don’t, PLF will continue to represent APRNs in court.
